Wednesday, February 6, 2013

FAQ Part III!- Letters To The Editor

I decided to compile some
of the questions I’ve received from readers of my blog, in the hopes that it
could help other people going through similar situations. ABA is such an enigma
(quite similar to Autism) in that it is very simple and very complex at the
same time. When I explain ABA to teachers or parents they often say something like “Oh
that’s what ABA is?? But that’s so simple! I already tried that”.

Yes, on the surface
ABA can seem very easy because at its core it is simply Operant conditioning. It is the application of
ABA that can be quite complex. It is knowing which technique to choose, how to
implement it, when to modify it, and what to do when it isn’t working that
trips many people up. For this reason there are many people out there who think
they are “doing ABA” but they really aren’t.

Many people who
read my blog send me comments or feedback about posts they liked --or didn’t
like-- or things they’d like to see on the blog. I also get lots of questions
from professionals and parents. From the types of questions I receive it’s
clear that there are many, many people out there dealing with difficult
behavioral problems in their homes or classrooms.

The purpose of this blog
is to share ABA with people and provide a place for encouragement and
resources. I didn’t expect this blog to be read by so many people, and I have
learned a lot about what ABA and Autism look like in different countries just
from hearing from my readers.

I greatly
appreciate everyone who takes the time to comment, email me, or purchase one of
my books. I really do read all of
the emails I receive, and I am touched by many of them.

Q- “My son wont stop banging his head on the living room floor/My daughter
screams if you turn the TV off/ How do I get my child to stop doing
______?”

A- I get a lot of
questions of this variety, with the same theme of “What do I do about XYZ”
behavior. Behavior reduction is not that simple, and it’s not that cut and dry. When
trying to intervene on a problem behavior it’s important to complete the
FBA process, create a behavior plan, and then implement the plan. A
professional can’t know with confidence what to do about a specific behavior
just from hearing a few details about it. We need information to provide us a
clear snapshot of the behavior so we can formulate an idea of why the behavior
is happening, and what to do about it.

Q- “My son has Autism, and he is 8. The school wants to place him in a
self contained classroom but I really want him to be in an inclusion classroom.
Which one is better?”

A- The decision on whether
to place a special needs child in a self contained classroom or a typical classroom
will vary from child to child. Does every child with Autism automatically need
to be in the “Autism classroom”? No. I have seen situations where my clients
should have been transitioned out of their self contained classroom a LONG time
ago, and I have also seen situations where my client was drowning trying to
make it in a typical classroom. While it is important that children with
special needs do not spend all of their time around other children with special
needs, it is also unfair to the child to place them in a classroom setting that
is far too advanced for them. Ask yourself: Is the child benefiting from being
placed in a self contained classroom? Will a classroom aide be available, who
is properly trained on Autism and ABA? Does the child exhibit problem behaviors
that would cause social stigma in a typical classroom? Can the child learn in a
variety of settings, or are they only at the point to learn from 1:1
instruction? If the child is in a self contained classroom, can they do a pull-
out for any part of the day and go into a typical classroom? Questions like
these will help to make educational placement decisions.

Q- “My son is working on a Waiting program in his ABA therapy. He talks to
me during the program and likes to play with the timer. Is that okay? What is
he supposed to do as he waits?”

A- It isn’t uncommon that
vocal (verbal) children will talk to the therapist during a waiting program,
ask questions, or try to gain the attention of the therapist. It really depends
on why the child is talking. If the child is attempting to plead or bargain for
the item they are waiting for, then no you shouldn’t respond to that. However,
some kiddos like to narrate what they’re doing, such as saying “I’m waiting” or
they may engage in some vocal stimming while waiting. I don’t see anything
wrong with that. The child definitely should not be allowed to play with or
hold the timer. In the natural setting, if the child is told to “wait” the
expectation is they will wait calmly and appropriately without trying to reach
for or touch the item they are waiting for (such as waiting in line, waiting to
start playing a game, waiting for a cup of juice, etc). Teach the skill of
waiting correctly during tablework, and it should generalize well to natural
environments.

Q- “Why do I need a BCBA/What does a BCBA do?”

A- A Board Certified
Behavior Analyst, or BCBA, is a person who is qualified to manage, oversee, and
supervise direct staff (ABA therapists). BCBA’s are trained in analyzing
behavior, conducting behavioral assessments, behavioral theory, data
collection, and much more. The ABA therapist is the person who works with the
child directly, usually in a 1:1 format (a BCBA can work as a direct therapist,
they just usually don’t). Typically there will be at least 1 person over the
ABA therapist acting as a supervisor. The reason it is preferable that this
person be a BCBA is because of the knowledge and expertise necessary to
supervise an ABA program. Many professionals without BCBA certification are not
equipped to modify, manage, and intervene on behavior. For example, the ABA
therapist may be knowledgeable about parent training and teaching skills, but
they may not have understanding of why to avoid punishment techniques, or how
to conduct a FBA.

Q- “I was able to secure some funding for ABA, but there are no providers
in my area”.

A- This isn’t an unusual
problem. Depending on where you live, there may be ABA agencies falling out of
the sky. Or there might be one agency with a 2 year long waiting list or ridiculously
high rates. You have two options depending on the requirements of the funding
source. You could find laypersons and get them trained, such as teachers,
paraprofessionals, the babysitter, etc. With proper training and supervision
any of these individuals could be used as an ABA therapist. However, some
funding sources specify that they will only pay for ABA services performed by a
BCBA. If that’s the case, you could hire a BCBA who does not live in your area.
They could provide long distance consultation, in addition to traveling to your
home for in-person trainings or visits. The BACB website has an
international directory of Board Certified professionals.

Q- "I enjoy reading your blog 'iloveaba.com' because I find it resourceful and informative. I
have been doing ABA for slightly over a year and I really love it.
Although, there are times I am stressful and worried especially during
team meetings. I am quite a shy person thus team meetings with other therapists, consultant, and the parents is a little too overwhelming for me. As
each of the therapists have to do a short session with our boy, I find
myself getting anxious and jittery whenever it's my turn. I
tried to ignore their presence in the room but I still feel so anxious that I end up making mistakes and not being able to perform well. I sense that the boy knows my emotions because most of the time when it's my turn, he will have tantrums or refuse to comply.

Does this happens often to ABA therapists? Could you share how I could overcome this problem?Like you, I am passionate about ABA but I don't seem to know how to overcome this fear and shyness in front of so many people."

A- I can SO relate to what you describe! I have definitely been in
that situation. My very first client in this field used to have these huge
training meetings that combined the home staff and school staff and we
would have to take turns working with the child...while also being
videotaped. It was incredibly stressful and I used to hate those
meetings :-) Looking back on it, what changed the situation for me is
when my confidence grew. I used to feel timid, uncomfortable, and
panicked doing therapy in front of everyone because I was scared I would
make a mistake, or do something wrong. But to learn in ABA, you have to
make mistakes! That's how learning happens. I know how scary it is to
perform therapy while people watch, but its a valuable learning tool and
it will make you a better ABA therapist. The only thing that can build
your confidence (besides time) is really striving to become better. Watch ABA training DVD's, read books, read research articles,
ask questions of the consultant, and I also recommend taping your own therapy sessions. Kind of like how football coaches review tapes of great games, as an ABA therapist it can be very helpful to view tapes of your own sessions and critique your performance.

As your
confidence grows, the fear will go away. Also the child is very likely
responding to your timidness and lack of confidence by testing you.
That's why he starts to act up. You have to show him that you are not
going to allow that behavior no matter who is watching. Over time he
will realize that you aren't kidding around, and he will stop.

Q-“I was told that my child is too high-functioning to use Applied
Behavior Analysis (ABA) because she is verbal and relates to other people. Is
it true that ABA is best used with children who are lower functioning?”

A- I have heard this myth
before that ABA is only for young kids or low functioning kids. However, that
simply isn’t true. I have worked with children all over the Spectrum, who varied from low functioning to high functioning. ABA can be
successful for older kids as well as adults. It all depends on what the goals
are. ABA therapy with a teen may focus on more
cognitively advanced skills that the child has deficits in, such as dating,
employment, joke telling, puberty issues, etc. Progress is possible when using
ABA with an individual of any age. Some funding sources severely minimize or
cut off funding for children over a certain age (usually 8), because of the
belief that “recovery” is no longer possible so there’s no point to therapy.
This does not mean that ABA can’t help a teen or adult, it just may be
difficult to find a funding source to pay for it.

Q- “When I started working with my student (26 months now), he did not
speak and had many communication difficulties. Now he is speaking (not in
sentences yet) and repeating everything he hears! However, socially, he is
still not making as much progress as I would like him to be making. We
just had him enrolled in a toddler class for 2-hours/week, which his mother and
I will be attending with him. He does not play with other children and
does not want to participate in any activities. These isolating behaviors
are worrying his family and I would like to be able to help him with this.”

A- The social issues you
describe need to be taught. It sounds like a skill deficit, so putting him in a
social setting wont be very successful because he lacks the ability to know
what to do and how to engage. You can’t generalize a skill that doesn’t exist
yet. Even if he can socialize with you or with Mom, that may not automatically
transfer to being able to generalize socializing with children. I would suggest
writing 2-3 social skill programs and also setting up more playdate situations
where it is just you, the child, and a peer. In the play date you would be
targeting appropriate social interactions such as eye contact, sharing, and
conflict resolution.

Q- "I was just hired as a middle school teacher with 8 students who
have autism. I'm reaching out to you to
ask advice as to how to approach my students on my first day.”

A- The suggestions I have
for you are the same ones I would give to a therapist going to work with a new client. You want to start off by building and establishing rapport, taking
baseline data, and observing/analyzing behaviors. I know it’s a bit different
for you because you have many students, not one child you are working with. I
would suggest creating time blocks in the day where you are interacting with or
observing/taking data on specific students. So maybe during Circle Time you
observe and collect data on 2 students, and then during recess you interact
with 2 different students. Just keep rotating through until you have the
information you need on all students. This information will be invaluable to
you once you start teaching, and it will help you to differentiate instruction
among the students (which I believe should happen in every classroom).

Q- “My son is 9, and we have been struggling with severe problem behaviors
for quite some time. A while ago we were given one technique to deal with his cursing.
That was that every single time he cursed, I was to send him to his room. Being
an untrained parent, I dutifully obeyed. If we were at the park and he cursed,
we came home and he went to his room. If we were eating dinner and he cursed,
he was sent to his room. If we were food shopping, we immediately left the
store and he went to his room. His base time was for 5 minutes. As he was going
to his room, I was to add a minute for every curse uttered. He grew to love this, and the cursing only
increased. When I mentioned to the case manager that his cursing was increasing
and he was smiling while cursing, she just said that I wasn't following through
with the timeout!”

A- Based on the
information you have shared, it does sound like his cursing is a way of being
sent to Time Out so he can escape a situation. Typically with escape maintained behaviors the intervention is to not allow escape no matter
what. Unfortunately, Time Out is one of the most misused behavioral strategies
that I come across. “Time Out” is actually short for Time Out from Reinforcing Activities. In other words, if the child
is engaged in something reinforcing then Time Out is likely to be effective. If
they are doing something they really don’t want to do and you place them in
Time Out, what just happened? They got to escape a dreadfully boring task. So
in the future when they want to leave a store, stop doing a task, or get out
of a demand, they will act up in order to be sent to Time Out.

Q- “I'm thinking about working for an autism organization as a line
therapist this summer and am wondering if you have any advice for me. Do you
like your job? How difficult or consuming is it to be a line therapist?”

A- I get many questions like this. Being an ABA therapist
is definitely not a job for everyone. I love what I do, but I have seen
therapists get hired and very quickly quit. It depends. Not all companies are
created equally, so sometimes you can work for a company that is
unprofessional, treats staff badly, and pays very little. So that could cause
someone to leave the field because they think all companies are like that. How
difficult the job is will depend on the training provided to you, and how much
support the company gives you. Also the more you learn and as your experience
grows, you will become more confident in your abilities which will also make
you like the job more. Here is a helpful post for anyone interested in entering the field of
ABA.

Q- “I have a 6 year old son who has high functioning autism. He is potty
trained fully for the day time but we are having a difficult time taking him
out of the pull-ups at night. I've google searched for social stories regarding
this issue but have not found any. Do you have any stories you can share or any
links you can give me?”

A- If you can’t find the
kind of social story you are looking for, you can always write your own. It’s
not difficult. Go to Carol Gray's website and view the
information about how to make a social story and what content it needs. Include
photos of your child, use language that is at his level of understanding, and
start teaching him using the story. Here is a link to writing your own social stories. Good luck!

Q- “I have a heart for people, especially
kids with Autism. I want to go to school but am having a hard time choosing a
degree. I am creative and systematic, very much a puzzle solver and I get bored
quick the same old routine everyday. Would behavioral
analyst/specialist/consultant be a good career choice?”

A- If you want to become
an Autism Consultant, which is a BCBA, then the BACB website lists the
specific degrees required to obtain certification. In addition to a degree, you need specific coursework (which may or may not have been part of your degree program), you need to be supervised by a BCBA while you gain ABA experience, and you must pass a rigorous exam.
Oh, and if you decide to become a BCBA don’t worry about being bored. There is
so much variability to the field! You can decide where you want to work, with
what ages, and the daily duties change based on who your clients are. It’s
definitely not a typical 9-5 job, which is what I love about it!